Healthcare Provider Details

I. General information

NPI: 1417977489
Provider Name (Legal Business Name): DARREN A TABECHIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RED CREEK DR SUITE 240
ROCHESTER NY
14623-4273
US

IV. Provider business mailing address

400 RED CREEK DR SUITE 240
ROCHESTER NY
14623-4273
US

V. Phone/Fax

Practice location:
  • Phone: 585-486-0901
  • Fax: 585-340-5399
Mailing address:
  • Phone: 585-486-0901
  • Fax: 585-340-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number226298
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number226298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: